Patients: demand timely care

Although Canadians have timely access to some health-care services, writes Dr. Desmond Leddin, not all patients have family doctors and many endure long wait times to see specialists. Above, plastic surgeon Dr. Jason Williams is shown in a consulting room at the Queen Elizabeth II Health Sciences Centre in Halifax. (AMac Photography)

The Wait Time Alliance of Canada (WTA) is calling on governments to implement a health-care consumer charter of rights and responsibilities. This would specify targets and enforceable maximum wait times for patient access to care.

Wait times in Canada are among the longest in the developed world. The alliance is a nationwide group of primary care and specialist physicians working with the Canadian Medical Association to try to improve this unfortunate reality. Over the last 20 years, there has been a shift of care from in-hospital to outpatient settings but the organization and resources necessary to run an efficient outpatient system have never been put in place. The result is a hospital-based system that works reasonably well, but which is very difficult to access, and an outpatient system that is near the bottom of the developed world’s worst. Consumers queue up at every level and many people don’t even have a family doctor. If they do, they will find that their family doctors face hurdles to access specialist services and basic diagnostic services.

Waiting for care hurts. The person waiting suffers and this has an impact both on the patient’s family and workplace. Family doctors spend endless frustrating hours trying to access the services, which they need to function in the community. Hospital-based physicians join the lineup to access diagnostic services and live with the impossibility of providing complex care in an ambulatory setting. Economists have estimated that delays in providing care cost the country more than $16 billion a year in 2008. It is probably worse now.

How can we be performing so poorly, given that Canada is one of the world’s richest economies, has some of the world’s finest universities, and produces high-quality medical and health administration graduates? There are many reasons but at least part of the problem is that our health-care system is a monopoly. Worse, it is a monopoly with no established standards of customer service. Let’s say that you need to go to Toronto but on stepping up to buy your ticket, you are offered a seat in two to three years. Most of us would pick another airline. As a health care consumer, you have no choice but to take what you are given. Right now you have no right to expect anything different. We think that should change.

We can live in the hope that government, or the health-care system itself will begin to reform but thus far change is glacial. The alliance has called for an empowerment of the consumer. The alliance wants governments to introduce a patient guarantee of access to consultant care and initiation of treatment with a maximum of 18 weeks. For some conditions, this would be much shorter, but this is the upper time limit of what would be acceptable. It is not great but at least it is better than no guarantee of service at all. We have taken this idea from the National Health Service in the United Kingdom, where the guarantee was introduced a number of years ago. There is little downside to making this change. It might lead to the redistribution of some resources from the hospital side to the ambulatory but that would not necessarily be a bad result. On the upside, it may force a change-resistant system to reform. Once a target is in place, people will hopefully feel sufficiently empowered to insist on their newfound rights and drive change in the system. If the system will not change from within, let’s force change in the system from without.

In Nova Scotia we now have an excellent window to make this change. The government has quite rightly made a decision to amalgamate the health districts. As planning moves forward for the new super district, let’s make sure that timely access to care is built in as a founding principle. A decision has yet to be made on the appointment of the new chief executive officer for the combined districts. There is an opportunity now to ensure that one of the deliverables for the holder of that position will be timely access to outpatient services for those in need of health care.

Wishing for a guarantee of timely access will not make it so. If you are a consumer of health care, a future user, a member or volunteer with a patient advocacy group, then contact your MLA and tell your representative that we should have a wait time guarantee. If there is enough support it might even happen.